Comparison of trained clinician ratings with expert ratings of aspiration on videofluoroscopic images from a randomized clinical trial.
Accurate detection and classification of aspiration is a critical component of videofluoroscopic swallowing evaluation, the most commonly utilized instrumental method for dysphagia diagnosis and treatment. Currently published literature indicates that interjudge reliability for the identification of aspiration ranges from poor to fairly good depending on the amount of training provided to clinicians. The majority of extant studies compared judgments among clinicians. No studies included judgments made during the use of a postural compensatory strategy. The purpose of this study was to examine the accuracy of judgments made by speech-language pathologists (SLPs) practicing in hospitals compared with unblinded expert judges when identifying aspiration and using the 8-point Penetration/Aspiration Scale. Clinicians received extensive training for the detection of aspiration and minimal training on use of the Penetration/Aspiration Scale. Videofluoroscopic data were collected from 669 patients as part of a large, randomized clinical trial and include judgments of 10,200 swallows made by 76 clinicians from 44 hospitals in 11 states. Judgments were made on swallows during use of dysphagia compensatory strategies: chin-down posture with thin liquids and head-neutral posture with thickened liquids (nectar-thick and honey-thick consistencies). The subject population included patients with Parkinson's disease and/or dementia. Kappa statistics indicate high accuracy for all interventions by SLPs for identification of aspiration (all kappa > 0.86) and variable accuracy (range = 69-76%) using the Penetration/Aspiration Scale when compared to expert judges. It is concluded that while the accuracy of identifying the presence of aspiration by SLPs is excellent, more extensive training and/or image enhancement is recommended for precise use of the Penetration/Aspiration Scale.
Hind
Jacqueline A
JA
School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA. jahind@wisc.edu
Gensler
Gary
G
Brandt
Diane K
DK
Gardner
Patricia J Miller
PJ
Blumenthal
Loreen
L
Gramigna
Gary D
GD
Kosek
Steven
S
Lundy
Donna
D
McGarvey-Toler
Susan
S
Rockafellow
Susan
S
Sullivan
Paula A
PA
Villa
Marybell
M
Gill
Gary D
GD
Lindblad
Anne S
AS
Logemann
Jeri A
JA
Robbins
JoAnne
J
D000368:Aged; D000369:Aged, 80 and over; D003679:Deglutition; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology; D003704:Dementia / Q000150:complications*; D005260:Female; D005471:Fluoroscopy; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications*; D011361:Professional Competence; D053120:Respiratory Aspiration; D013070:Speech Therapy; D013066:Speech-Language Pathology; D014741:Video Recording